The independent evaluation of the Global Financing Facility (GFF), published in April 2025, offers a unique opportunity to reflect on ten years of work at the intersection of health financing, equity, and systems strengthening. As an active member of the GFF’s civil society coordinating group, Wemos has been closely involved in contributing to and monitoring the GFF’s evaluation processes. Our commitment to promoting stronger, more equitable health systems has driven our engagement with the GFF, including providing input to the evaluation steering committee and conducting research on key issues such as alignment, coordination, and the impact of blended finance on health equity.
We went through the report’s 400+ pages and read about the success stories and the main challenges. While it highlights several important achievements, it also points to strategic blind spots – particularly around blended finance and the support to the private sector in providing healthcare. Below, we reflect on key takeaways, lessons learned and suggest future directions for the GFF.
One of the GFF’s most tangible contributions has been its support for domestic resource mobilization. The evaluation confirms that in countries such as Tanzania and Nigeria, the GFF helped improve public financial management, enabling ministries of health to track spending, advocate for increased allocations, and align domestic resources with health priorities. In Tanzania, the health budget grew from 8.6% to 16.5% of total government spending between 2016 and 2022. In Nigeria, support for the Basic Health Care Provision Fund catalysed state-level investments in primary health care.
The GFF’s efforts to build countries’ capacity to finance their own health systems should be scaled and prioritized and should be part of the next strategy 2026-2030.
The evaluation also documents the GFF’s contributions to health system strengthening and primary healthcare delivery, including improvements in health information systems, quality of care and results-based budgeting.
In Indonesia, for example, GFF-supported stunting reduction initiatives led to measurable improvements. In Cambodia, Somalia and Guatemala, the GFF helped implement more strategic purchasing mechanisms and district-level planning processes. These are foundational investments that protect the most vulnerable populations and ensure the sustainability of reproductive, maternal, newborn, child and adolescent health services.
These contributions are linked to the improved alignment between the GFF and country priorities and plans, in line with Wemos’ contributions and suggestions for many years. The evaluation found that in countries like Malawi and Côte d’Ivoire, the approach of the GFF was well aligned with the national health strategies and contributed to stronger country ownership.
Also, GFF mechanisms such as the ‘Investment Case’ and the ‘Resource Mapping and Expenditure Tracking’ helped integrate GFF programmes and funding into the broader healthcare systems. Governments also appreciated the ‘One plan – One budget – One report’ approach, in which all health financial resources are combined to fund a single national health strategy. Implementation progress and results are documented in a single report system. This is one of the greatest strengths of the GFF, from which other global health initiatives should take inspiration.
The evaluation states that the GFF’s private sector engagement strategy – particularly its attempt to mobilize blended finance – has not delivered on its promise. The report attributes the limited success in attracting private investment to the underutilization of the “GFF’s ability to advocate for private sector solutions, requiring clearer engagement strategies and incentives for investments”. However, it glosses over the GFF’s failed attempt to collaborate with the International Finance Corporation (IFC) to attract private investments – for example, through the Africa Medical Equipment Facility (AMEF)
The absence of the AMEF from the GFF’s final evaluation is concerning, especially because the evaluation recommends further investment in blended finance and stronger collaboration with the IFC.
Private investment in healthcare service delivery remains concentrated in wealthier, urban markets and risks exacerbating inequalities if not carefully regulated.
While private sector engagement – i.e. regulating private providers, integrating data systems, setting quality standards – is important to advance healthcare access, it must be clearly distinguished from promoting private healthcare provision, which often results in disparities in access, affordability and quality. In particular, no argument supports allocating scarce GFF resources to private healthcare providers. This is not only ineffective but at odds with the goals of universality and equity that define the GFF’s mission.
The report highlights mixed results in terms of meaningful engagement of civil society. While the GFF tried to more actively include civil society, underfunding and inconsistent engagement are still an issue. Interviewed civil society organizations (CSOs) mentioned issues such as “tokenistic involvement, infrequent meetings, not receiving invitations to meetings or receiving them too late, government selection of CSO representatives, and short-term funding for CSO work”. Ensuring civil society’s role in providing an independent accountability system within the GFF is essential, especially in these times of shrinking civil spaces.
The GFF will now work on its strategy 2026-2030, drawing from the lessons from this evaluation. The next phase should be guided by the principles of the Lusaka Agenda, in particular strengthening primary health care, promoting equity and advancing local manufacturing.
Partnership with the IFC to support local manufacturers, rather than health service provision. One area where collaboration with the IFC could be more appropriate and impactful is to support local manufacturers. Investing in regional pharmaceutical production, diagnostics and health technologies aligns with both industrial development and public health objectives. It also responds to a growing global consensus on the importance of supply chain resilience, particularly in low- and middle-income countries, and the need to shift away from long-standing patterns of dependency on high-income countries toward more autonomous and equitable health systems.
Inclusion of the Principles for Meaningful Involvement of Communities and Civil Society in Global Health Governance into the next strategy. In May 2024, the GFF publicly endorsed the Principles for Meaningful Involvement of Communities and Civil Society in Global Health Governance. To follow through on this commitment, the principles must be fully reflected in both the 2026–2030 strategy and the new framework on civil society and youth engagement.
The final evaluation provided important insights into the successes and points of improvement in the GFF’s mission to improve the health and nutrition of women, children and adolescents. As the GFF develops its new 2026-2030 strategy, it should seize the opportunity to build on what has worked – support for domestic resource mobilization, focus on primary health care, and strengthening health systems – and to re-evaluate what has not, particularly the approach to blended finance and promoting private healthcare provision.
To truly deliver on its promise of equity and sustainability, the GFF must place stronger public systems, deeper country ownership, and meaningful civil society engagement at the heart of its strategy. The future of global health financing does not depend on financial engineering, but on public leadership, domestic capacity and political will.
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